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Washington is among the states best prepared for implementing the Affordable Care Act. If so, there must be 49 monumental migraines out there.

Tuesday, the Washington Health Exchange Board refused to certify 31 insurance plans for submittal to the U.S. Department of Health and Human Services. The plans from four carriers were the only ones that complied with all of the requirements established by Insurance Commissioner Mike Kreidler.

Washington is among the states best prepared for implementing the Affordable Care Act. If so, there must be 49 monumental migraines out there.

Tuesday, the Washington Health Exchange Board refused to certify 31 insurance plans for submittal to the U.S. Department of Health and Human Services. The plans from four carriers were the only ones that complied with all of the requirements established by Insurance Commissioner Mike Kreidler.

The exchange board wants as many plans available as possible. So do we.

The commissioner wants to be sure the insurers have the hospitals, doctors, pharmacists and other professionals ready to provide the services clients are paying for. He suggests that forcing patients to drive two hours to a gastroenterologist may be unreasonable.

Five carriers did not meet Kreidler’s midnight, July 31 deadline for filing acceptable plans. Two, maybe three, will have appeals of Kreidler’s decisions heard next week by an administrative law judge, who would almost have to making a ruling immediately if the HHS Aug. 31 deadline is to be met.

Did we mention there are a lot of deadlines?

Kreidler says favorable rulings from the judge would be unfair to the four carriers – Lifewise Health Plan, Group Health, Premera and BridgeSpan Health Co., a corporate relative to Regence BlueShield – who got some of their plans approved, but had to set aside others because they could not comply with every Kreidler requirement by deadline.

He admits to being a stickler, in part because he expects the federal exchange that will be the default for states such as Idaho may not have anticipated, or will not be able to monitor, plans that are not sold where carriers said they would be sold, or are sold where not approved, or provide the same services wherever sold, and at the same price.

Meanwhile, his office has been forced to move on to reviewing the more numerous individual and small business plans that will be sold outside the exchange. That market will be at least as robust as the exchange, but buyers will not have access to the subsidies that will help individuals who buy coverage through Healthplanfinder, the Washington exchange.

Just to add to the chaos, all the plans must be approved on the same timeline. The insurers normally come in with their plans and rates one at a time.

The exchange and commissioner’s office have the same goal: putting as many health insurance options as possible before the public and assuring consumers get the insurance protection they paid for.

We would like to see as many carriers in the marketplace as possible. Distant access to a gastroenterologist or other provider may be acceptable to a consumer if the premiums are right.

Nothing will be simple in the implementation of Obamacare, which has the fundamental goal of improving access to health care services. More insurance does not necessarily mean more quality care – in fact, it can mean less – but if more choice is an objective, then start with more choice.